As a supporter of Cancer Research UK (CRUK) I have found myself faced with a bit of dilemma recently. I am very familiar with the excellent work performed by its many scientists but am unhappy that it has embraced ASH and deeply concerned by what I see as a change in emphasis away from scientific research towards political advocacy. Symptoms of this malaise include a slogan shift from “beating cancer through research” to the worryingly trite “together we will beat cancer”, propaganda on lifestyle links to cancer badly dressed up as science and a tendency to employ increasingly strident spin doctors.

I don’t believe that half of cancers are “caused” by lifestyle factors and even if that were true then I am not convinced that trying to force mass behavioural change is socially acceptable or likely to succeed on a major scale. So despite what the nutritionists would have us believe, in my view funding laboratory research is a lot more important than banning ham from children’s lunches.

In most countries medical research largely government funded but the UK relies heavily on the Wellcome Trust (£700M) and charities who according to AMRC contribute around a third of approximately £3 billion public spend on medical research. CRUK is a major player contributing over £300 Million.

CRUK receives the vast majority of its revenue from donations, so a significant percentage of the UK medical research effort is dependent on its ability to attract public support. That ability has been called into question in recent years. Fund raising has flat lined to the extent that this year CRUK felt obliged to spend £687,000 “refreshing” its brand and an unspecified amount on a TV advertising campaign.

In justifying this revamp CEO Harpal Kumar says:

“We’re showing our age – our brand was created 10 years ago … We’re also looking out of touch at a time when the economy is fragile and the public have more choice than ever before.”

I believe that CRUKs image problem is partly self-inflicted. 10 years ago its message was clear and people knew that they were donating money for scientific research. These days in CRUK’s research directory, listed alongside talented scientists that include Nobel Laureates we find Deborah Arnott of ASH, an anti-tobacco activist who is a stranger to science, research and on occasion objective reality.

CRUK spends the vast bulk of its money on research but lifestyle pseudoscience sensationalised by its spin doctors often makes headlines whereas the excellent work of its laboratory scientists rarely does. This effect influences public perception and unpopular campaigns such as plain packaging for cigarettes may actually damage the CRUK brand.

The contrast in quality between CRUK’s laughable “research” intended to “prove” that the plain packs vanity project is evidence based and the scientific research performed by its laboratories is startling and should be embarrassing.

The plain packs campaign also highlights the extent to which CRUK has allowed activism to dominate its public image. Shortly after the government decision not to adopt the measure the BBC claimed to quote CEO Harpal Kumar as saying:

“The government had a choice: protect children from an addiction that kills 100,000 people in the UK every year or protect tobacco industry profits,”

This statement was subsequently removed from the BBC article presumably at the request of someone at CRUK who realised that manipulative language and speculative political accusations are inappropriate from the CEO of a charity. Perhaps what I had presumed was a typo on the Plain Packs campaign website is actually an allusion to Kumar’s political ambitions. Kumar is of course only thinking of the “the children”. He does a lot of that.

One might hope that a lesson had been learned but the publication of a poor quality study in BMJ Open that deservedly received a lukewarm reception from virtually everyone apart from public health worshipers led to a somewhat misleading press release from CRUK that was further spun by the mainstream media to suggest that plain packaging has had a measurable impact in Australia. The public was subjected to extraordinary claims by Kate Alley of CRUK courtesy of the BBC:

“When cigarettes aren’t disguised by flashy packaging and carefully crafted branding, smokers see them for what they are – a lethal product which kills half of its long term users.”

“85% of the British public wanted government action to reduce the number of children who smoke.”

Both these statement are disingenuous. The first is extremely unlikely hypothesis and the second is an attempt to divert attention from a lack of public support for a specific measure by introducing a dubious contextually irrelevant statistic to imply that support exists. CRUK should be embarrassed by such slyness but instead diverts donations intended for research to producing spin.

This manipulative technique has been used by CRUK activists in their latest attempt to browbeat the government using yet another YouGov survey in which leading questions are asked and the “right” answers are then spun into policy based evidence. Presenting the results of such surveys as “evidence” for policy is bordering on fanaticism and so far removed from the scientific rigour that is the keystone of CRUK’s core activities that I am sincerely surprised that it is tolerated.

CRUK argues that it is merely continuing a history of advocacy but there is an ethical chasm between advocating informed choice based on hard evidence presented by scientists and authoritarian “denormalisation” campaigns fronted by advocates and PR people. This increasingly coercive and unscientific approach may appeal to activist supporters but such people are hardly representative of the wider population whose donations are what really fuels cancer research. Historically, the UK public has been lukewarm to heavy handed government interventions and I fervently hope that no amount of rigged YouGov surveys will change that.

I don’t expect CRUK as a cancer charity to be supportive of smoking but I believe its output on the subject should be well researched and objective. It is far from that standard at present. This year’s figures suggest that the advertising is helping fundraising but I can’t help but feel that the money might have been better spent and I also believe that support may depend a little on the probability that most donors are blissfully unaware that their money might be diverted to support aggressive advocacy.

There are hopeful signs that someone has got the message as CRUK advertising at least is now focussed on research but I note that ASH funding was renewed in 2013. Didn’t anyone notice the lack of public support for ASH before rushing to adopting its philosophy and tactics?

The government’s decision not to go ahead with “plain” packaging for cigarettes was welcomed by most sane reasonable people as an indication that we may finally be seeing a beginning of an end to the madness that is government by pressure group.

Only true public health disciples believe that the campaign is anything more than a vanity project intended to bash “big tobacco” and show just how powerful the activists have become. There is no credible evidence of any likely health impact whatsoever and one can be forgiven for concluding that some activists are so wrapped up with winning their “war” with big tobacco that they view health as a peripheral objective. Others seem more interested in topping some sort of public health competition to determine which nation can be the most authoritarian.

The response of the public health industry to the plain packs setback has been predictable and sad. Refusing to even acknowledge the public or its opinion, it has responded with a wave of unpleasant speculation and conspiracy theories based on the now very tired claim that the only opponents of the activists are in the pay of “big tobacco”.

This is not even remotely true but the strategy that it underpins has nonetheless been amazingly successful over the years because it has proved much easier to undermine opponents and demonize the tobacco industry than it has to rationally justify most of what tobacco control has campaigned for. It has in fact been so successful that we now live in a society in which a person’s research or opinion however valid in its own right can be effectively dismissed by any association, however tangential with the tobacco industry. Although we do need to be alert to the influence of vested interests, the current state of affairs is lamentable and should be a source of shame to those who have created it.

The media has played a major role in the growth of what can be termed censorship by association as a result of monumental ignorance and the love of a “good smear story”. The Guardian is particularly enthusiastic when it comes to bashing industries that try to turn a profit and being staffed, for the most part, by people who would prefer not to do anything quite so vulgar themselves, provides many natural allies for public health activists.

The latest mouthpiece for Deborah Arnott’s ASH is Jamie Doward who treated us to a major scoop in this weekend’s Observer by exposing a “sophisticated lobbying campaign” by Philip Morris Industries (PMI) apparently intended to prevent plain packs being adopted in the UK. It appears that someone leaked some 2011 PMI files intended for internal use only and from those files the intrepid Doward has managed to concoct a deeply dishonest and frankly ridiculous conspiracy theory in which organisations such as the IEA, TPA and UNITE are mere pawns in the hands of Machiavellian tobacco company executives.

In Doward’s fantasy, dissident smokers are unthinking recruits of “big tobacco” and absolutely no grass roots opposition to anything the tobacco control lobbyists have to say exists at all anywhere. The hundreds of thousands of signatures opposed to plain packaging don’t exist or are the product of manipulation by “big tobacco”. Lynton Crosby of course appears complete with photograph despite not apparently being directly involved in the leak.

It is of course entirely unsurprising that PMI analysed the politics surrounding the plain packs proposal in some depth but I would like to see the justification for Doward’s claim that the tobacco lobby has “spent millions” trying to derail the proposal in the UK. Having waded through his nonsense in search of anything that represented fact rather than fantasy I was struck by a section in which he reveals that those dastardly executives at PMI actually resorted to canvassing public opinion in their efforts to thwart plain packs. Apparently they used their endless resources to commission a small poll of a thousand people from marginal Tory constituencies and found that only 3% of people thought that action on smoking was a top priority for the government. I hope that the 30 are a sampling artefact for the sake of mankind. When it came to proposed smoking reduction measures 24% mentioned plain packs but 62% preferred education. Apparently Doward thinks that it is extremely naughty of PMI to expose the lack of public support for plain packs. I am trying to work out why.

Doward leaves the last word to Arnott who rarely fails to oblige with a manipulative meaningless sound bite. The Observer article is of a laughable standard but the underlying behaviour and the societal sickness of which it is but a symptom is no laughing matter. I look forward to next week’s instalment.

Back in 2009, Dick Puddlecote highlighted a particularly odious piece of behaviour from a member of the “caring” profession who had long before decided that he could make a greater contribution to our collective wellbeing and his bank balance by practicing politics rather than medicine. Chris Spencer-Jones attempt to close the legally exempt smoking room in a hospice on ideological grounds were of course ignored by the mainstream media presumably because it views people who hold medical degrees as saints who can never be shown to do anything other than good works for the rest of humanity. Fortunately the Birmingham Mail is rather less squeamish when it comes to exposing unpleasant ideologues and reported the Public Health Director’s inhumane efforts.

Obviously, Spencer–Jones was not fired or even reprimanded for what he did as common decency is not considered all that desirable in the modern public health bureaucrat. He soldiered manfully on, talking utter twaddle, attending meetings, preparing PowerPoint presentations and performing all the other duties of a public health official until 2012. The Birmingham Mail also soldiered on, exposing the fact that Birmingham had not one but at one stage five Directors of Public Health and that they cost £600,000 per annum between them. Two of them were paid more than the Prime Minister. Spencer–Jones was on over £145,000.

Spencer-Jones and his colleagues do appear to have been paid rather extravagantly for doing very little but they were by no means the highest paid public health bureaucrats in the land. Thanks to the Guardian’s report on civil service pay back in 2010 we can see that the highest paid Director of Public Health at that time was ardent socialist, champion of the NHS, opponent of big business and “plain” packs supporter Gabriel Scally.

I do not normally comment on the salaries of others but I am happy to make an exception in the case of public health because for many years it has been a gravy train for the not especially talented and those with political axes to grind. In recent decades it has cost many millions and delivered very little except for a more divided and unhappy society in which an increasingly judgemental approach is encouraged towards behaviours deemed unacceptable by a well-heeled elite. Huge sums have been spent on lifestyle propaganda whilst the people who work in “real” public health laboratories have had their budgets squeezed.

Gabriel Scally very publicly resigned in 2012 ostensibly because he doesn’t like the current government and what he thinks that it is doing to the NHS. He also doesn’t care much for responsibility deals and is upset by the very thought of elected governments treating legitimate companies that he doesn’t like as anything other than enemies of the state. Prior to resigning he apparently saw his staff shrink from 50 to 9, which although unfortunate for his staff, who I hope found something more worthwhile to do, has to be a very good thing overall. Similar good things seem to have been happening in Birmingham where at around the same time Spencer-Jones and his colleagues were reduced from four to one.

Earlier this year a paper was published in a peer reviewed journal that was so contrived and so flawed that I had hoped it would convince any doubters that the evidence for miraculous immediate health effects from smoking bans is entirely the figment of activist’s febrile imaginations. Sadly, it appears that I was wrong and that true believers including David Cameron still cling to the notion that smoking bans “have had a pretty dramatic health effect”. This delusion is shared by Anna Soubry who unforgivably and untruthfully claimed reductions in heart attacks and childhood asthma admissions as a result of the English smoking ban in evidence that she gave to the House of Lords (page 11). The fact that she was standing next to the less than impartial Andrew Black at the time is no excuse as only someone without interest in truth or reality would take anything Black says at face value.

The “growing body of peer reviewed evidence” used to justify these counter-intuitive claims is an indictment of public health industry ethics and medical journal standards. This recent contribution claiming a 12% reduction is asthma admissions as a result of the smoking ban originates from Imperial College London which is cause for further concern because Imperial is a top UK research establishment and as such charges young people a small fortune to be educated by what one would hope are top academics.

The culprits behind this affront to science are Stanton Glantz and Christopher Millett. In case anyone is labouring under the illusion that these two are objective scientists, Glantz is a well-known anti-tobacco activist who together with Millett holds extreme views on smoking in movies. Glantz was recently mentioned in the US congress in relation to a $680,000 grant that he used to make the bizarre claim that the Tea Party was created 25 years ago by big tobacco. It is extraordinary that we ban tobacco company funded research on the basis of scientific objectivity but, by a widely accepted double standard, treat the output of blatantly biased activist obsessives as “scientific evidence” fit for Prime Ministers.

This paper is yet another example of torturing numbers to fit a theory. The authors produce a lot of complex statistical waffle to obscure the deception but their essentially simplistic claim can be illustrated using annual data for childhood asthma admissions from the same NHS source they use. In the figure below the blue bars are years pre-ban and the orange ones the year of the ban and one year later. The solid red line is a simple linear fit to the pre-ban data.

The claim that the ban reduced asthma admissions depends on showing that admissions rates were increasing pre-ban and that after the ban admissions were lower than predicted had that trend continued along the path illustrated by the dashed red line. Millett uses the period 2002-2007 to model the “rising trend” in admissions but the NHS data goes back further and if we use all the available data the “trend” changes somewhat.

Cherry picking time periods is a common deception practiced by the public health industry together with taking advantage of coincidental variations in data series that happen to fit a theory or policy.

Those desperate to believe might argue that I am being too simplistic in that the “experts” took a more sophisticated approach and used monthly data. A 12% fall in admissions should not need sophisticated techniques to be apparent but it is true that 2007-08, the year of the ban, saw a big fall in admissions compared to the previous year. However, a look at NHS data for monthly admissions covering three years around the ban serves only to illustrate how the second element of the trick works.

If I asked a group of seven year olds which of the lines on the chart above was the odd one out, I would expect the majority to say the orange one. The orange line represents monthly admissions for the year before the ban. We can align the data on the month of July which was when the ban came in but it makes little difference. Admissions were low in the year the ban came into force but not unusually so. Both the alleged upward trend before the ban and the apparent fall in the year it was enacted work for the activists only because peak season admissions were unusually high in the year before the ban. That stroke of fortune combined with the cherry picked time frame form the basis of the deception.

This peer reviewed paper appears to be nothing more than a cheap trick, an abuse of academic freedom for political purposes. The authors admit to some of its flaws but this did not prevent them from issuing a carefully worded press release that inevitably led to a misleading claim being widely broadcast by a gullible and uncritical media. It even made BBC TV news! This is not an isolated incident. It forms part of a body of highly publicised but fundamentally flawed “research” that has led some politicians and at least one national leader to erroneously believe in unlikely health miracles associated with interventions such as smoking bans. This might well influence opinions when reviewing existing or considering additional interventions, which one can argue is the main purpose behind such publications and their attendant publicity.

Of course, those politicians obsessed with public health are never slow to accept even the most unconvincing “evidence” if it suits their prejudices. Despite widespread incredulity over the facile “evidence” underpinning the implausible notion that smoking bans produce big falls in heart attacks, Sarah Wollaston of minimum alcohol pricing fame has claimed that the UK smoking ban:

“…was a very good example of evidence-based policy. If you look at what has happened in terms of deaths of cardiac disease, it has been staggering. There’s been a huge drop … It surprised even the health experts.”

Wollaston exhibits blind faith in “evidence” that is of no better standard than the article reviewed here. Her need to believe does not make it true, or a good basis for policy.

I have contacted Pediatrics and asked how something so obviously contrived as the Millett paper could survive peer review. I was informed that it was reviewed by people who are “experts in their field”. I wasn’t told what field, but expertise in either mathematics or ethics was apparently not considered necessary in this case. There are reasons why political stunts like this usually appear in medical journals rather than elsewhere in the literature and it is remarkable just how low some set the peer review bar. Peer review is supposed to be a minimum requirement able to identify fundamental methodological errors or false claims. Every time an article such as this is published in a “peer reviewed” journal, respect for this gold standard and science in general declines a little bit further. The collective damage is becoming significant and the implications extend way beyond smoking.

I have also contacted Imperial College press office but they have declined to comment on why they inflicted this press release on the general public. From direct experience I know that Imperial College employs many excellent lecturers and research scientists but based on this output I think that we should question what exactly young people are being taught for £9,000 a year and who is doing the teaching. Honesty, integrity and academic excellence are qualities that I would expect to see in those who benefit from the fees young people are now being asked to pay. I appear to be in a minority.

It is coming up to year end for GP practices and that of course means that they will all be diligently filling in reams of paperwork for the DH in order to secure maximum funding via the QOF. In the doctor’s business journal medeconomicsDr Gavin Jamie gives some top tips on how practices can maximise their points score.

According to Jamie:

It is that time of year when practices are polishing their data and preparing for the annual inspection on 31 March of their QOF achievement.

For many it is a matter of pride, and not simply financial necessity, to get the most points that they can. Here are my top tips.

The DH is now effectively offering GPs a bounty on every smoker they can identify and attempt to “reform”, so it is perhaps not surprising that third on his list of top tips for achieving the warm glow of satisfaction that only comes from a good dose of centralist bureaucracy is upping the practice’s smoking score.

TIP 3 Smoking

This has become more complicated with the need to offer smoking cessation advice or prescribe therapy to all smokers over age 15.

Due to the way that this is calculated, improved coding of people who have stopped smoking will enhance the advice indicator.

It really is worth making every contact count – even where patient just calls into reception or speaks to the practice by telephone.

If you are the sort of person who takes pride in this kind of exercise or if your practice just needs the money Dr Jamie recommends that you hassle people about their lifestyles at every possible opportunity. I haven’t been anywhere near my practice because I am coming to hate the place. I wonder how many others feel the same and how long it will take for politicians to work out that this approach is counterproductive?

Surely even Dave can see that a system that encourages GPs to repeatedly annoy their patients is not a good thing. No doubt his DH advisors will claim to have “peer reviewed” evidence to the contrary and we can assume that it is the same advisors who tell him that minimum alcohol pricing will target alcoholics and that smoking bans have had dramatic immediate health effects. Surely at some point he will work out that these people are rather economical with the truth? Won’t he?